山东大学耳鼻喉眼学报 ›› 2014, Vol. 28 ›› Issue (6): 11-15.doi: 10.6040/j.issn.1673-3770.0.2014.160

• 论著 • 上一篇    下一篇

前壁外耳道-鼓膜瓣应用于开放式鼓室成形术31例

陈泽, 钟兆棠, 梁敏志   

  1. 高州市人民医院耳鼻喉科, 广东 高州 525200
  • 收稿日期:2014-05-12 发布日期:2014-12-16
  • 作者简介:陈泽.E-mail:gzent1210@21cn.com

Application of anterior wall of external auditory canal ardrum flap for open tympanoplasty in 31 patients

CHEN Ze, ZHONG Zhao-tang, LIANG Min-zhi   

  1. Department of Otorhinolaryngology, Gaozhou People's Hospital, Gaozhou 525200, Guangdong, China
  • Received:2014-05-12 Published:2014-12-16

摘要: 目的 探讨前壁外耳道-鼓膜瓣应用于开放式鼓室成形术中,能否提高鼓膜修补成功率和手术疗效.方法 对慢性化脓性中耳炎及中耳胆脂瘤伴中、下鼓室自行封闭患者66例(66耳),予开放式鼓室成形术治疗,其中31例术中应用前壁外耳道-鼓膜瓣内植法鼓室成形(前瓣组),35例应用软骨和筋膜内植法鼓室成形(软骨组),测定术前及术后6个月气导(AC)、气骨导差(ABG),比较两组的临床疗效.结果 前瓣组成功率为96.8%(30/31),软骨组88.6%(31/35),两组比较差异无统计学意义(P>0.05);前瓣组有效率为88.46%,软骨组为65.52%,两组比较差异有统计学意义(P<0.05),即前瓣组优于软骨组.结论 伴有中、下鼓室封闭的慢性中耳炎患者,行开放式鼓室成形术中应用前壁外耳道-鼓膜瓣鼓室成形能提高筋膜成活率,术后鼓膜穿孔率低,较好成形鼓室,并能同期听力重建,提高听力.

关键词: 化脓性中耳炎, 乳突根治术, 鼓室成形术, 鼓室封闭, 胆脂瘤

Abstract: Objective To investigate the application of anterior wall of external auditory canal-eardrum flap in open tympanoplasty to improve tympanic molding. Methods 66 patients (66 ears) with chronic suppurative otitis media or middle ear cholesteatoma accompanied with self sealing of mesotympanum and hypotympanum underwent open tympanoplasty. 31 cases were applied with anterior wall of external auditory meatus-eardrum flap (Anterior flap group) and 35 cases were treated with cartilage and fascia inner-transplanted method (Cartilage group). Air conduction (AC) and air bone gap (ABG) were performed six months before and after surgery. The clinical effect of the two groups were Compared. Results The success rates were 96.8%(30/31) and 88.6%(31/35) in anterior flap group and cartilage group respectively (P>0.05), while the effective rates were 88.46% and 65.52% correspondingly in the two groups (P<0.05). Conclusion For the patients with chronic suppurative otitis media accompanied with sealing of mesotympanum and hypotympanum, anterior wall of external auditory canal eardrum flap in open tympanoplasty can improve fascia survival and reduce perforation rate of tympanic membrane, with satisfying tympanic molding, simultaneous auditory rehabilitation, hearing improvement and good clinical effect.

Key words: Suppuratiove otitis media, Cholesteatoma, Mastoidectomy, Tympanoplasty, Sealing of tympanum

中图分类号: 

  • R764.92
[1] 王春华.活动期慢性化脓性中耳炎一期鼓室成型术[J].中华耳科学杂志,2004,2(2):103-105. WANG Chunhua. Tympanoplasty of one stage for chronic suppurative otitis media at active phase[J]. Chin J Otol, 2004, 2(2): 103-105.
[2] 沈字玲,金晓杰.鼓膜成形术的现状和进展[J].听力学及言语疾病杂志,2007,15(3):249-253 SHEN Yuling, JIN Xiaojie. Status and progress of myringoplasty[J].J Audiol Speech Pathol, 2007, 15(3): 249-253.
[3] 黄选兆,汪吉宝,孔维佳.实用耳鼻咽喉头颈外科学[M].2版.北京:人民卫生出版社,2008:883.
[4] 铁木尔·阿布列孜,曾进,马芙蓉.乳突根治术后不干耳临床研究[J].中华耳科学杂志,2010,8(3):248-253. Tomur Ablez, ZENG Jin, MA Furong. Clinical research of wet ear after mastoidectomy[J]. Chin J Otol, 2010, 8(3): 248-253.
[5] 中华医学会耳鼻咽喉头颈外科学分会耳科组,中华耳鼻咽喉头颈外科杂志编辑委员会耳科组.中耳炎的临床分类和手术分型指南(2012)[J]. 中华耳鼻咽喉头颈外科杂志,2013,48(1):5. Otology group of Otorhinolaryngology Head and Neck Surgery branch, Chinese Medical Association, Otology group of Chinese Journal of Otorhinolaryngology Head and Neck Surgery Editorial board. Guidance interpretation of otitis media clinical classification and surgery (2012) [J]. Chin J Otorhinolaryngol Head Neck Surgery, 2013, 48(1): 5.
[6] 刘良发,韩东一,杨伟炎.中耳乳突胆脂瘤的诊断和治疗进展[J].中华耳鼻咽喉科杂志,2003,38(2):157-160. LIU Liangfa, HAN Dongyi, YANG Weiyan. Progress of diagnosis and treatment for middle ear cholesteatoma[J]. Chin J Otorhinolaryngol, 2003, 38(2):157-160.
[7] 李正贤,李学佩,宋为明.开放式鼓室成形术治疗胆脂瘤型中耳炎疗效观察[J].中华耳科学杂志,2004,2(4): 254-256. LI Zhengxian, LI Xuepei, SONG Weiming. Cholesteatoma surgery: open tympanoplasty[J]. Chin J Otol, 2004, 2(4): 254-256.
[8] 杨伟炎.鼓室成型术适应证选择[J].中华耳鼻咽喉科杂志,1996,31(2):67-68. YANG Weiyan. Indication selection of tympanoplasty[J]. Chin J Otorhinolaryngol, 1996, 31(2): 67-68.
[9] 孙建军,刘阳.中耳炎的临床分类和手术分型指南(2012)解读[J]. 中华耳鼻咽喉头颈外科杂志,2013,48(1):6-10. SUN Jianjun, LIU Yang. Guidance interpretation of otitis media clinical classification and surgery (2012)[J]. Chin J Otorhinolaryngol Head Neck Surgery, 2013, 48(1): 6-10.
[10] Heermann J.Auricular cartilage palisade[J]. Tympano-epitypano-antrum Mast Plast Clin Otolaryngol, 1978, 3(3):433-446.
[11] Heermann J.Thirty years’ antograft tragal and conchal carlilage perichon-drium palisade tumpano-epitympano-antrum and mastoid plastics-13000 case[M].In:Charachon R,Garcia-Ibanez E,eds. Long-term results and indications in otology and otoneurosurgery.Amsterdam: Kugler,1991:159-164.
[12] 余力生,张会勇.耳软骨在中耳手术中应用[J].中华耳科学杂志,2003,1 (1):32-35. YU Lisheng, ZHANG Huiyong. Application of ear cartilage in middle ear surgery [J]. Chin J Otol, 2003, 1(1): 32-35.
[13] 陈泽,钟兆棠,梁敏志.双瓣法鼓膜修补术治疗鼓膜大穿孔[J].中国医师进修杂志,2014,37(12):22-23. CHEN Ze, ZHONG Zhaotang, LIANG Minzhi. Myringoplasty of double flaps treating tympanic membrane with large perforation[J]. Chin J Postgrad Med, 2014, 37(12): 22-23.
[14] Merchant S N, Mekenna M J, Rosowski J J.Current status and Future challenges of tympanoplasty[J]. Eur Arch Otorhio Laryngol, 1998, 255(3):221-228.
[15] 龙立新.鼓膜修补术94例临床分析[J].中华现代中西医杂志,2005,3(13):1166-1167. LONG Lixin. Clinical analysis of myringoplasty on 94 patients[J].Chin J Curr Trad West Med, 2005, 3(13):1166-1167.
[16] 王红权. 改良内植法鼓膜修补术63耳临床分析[J].中国医师进修杂志, 2009,33(21):51-52. WANG Hongquan. Clinical analysis of modified myringoplasty with inner-transplant method on 63 ears [J]. Chin J Postgrad Med, 2009, 33(21): 51-52.
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